Manganese

Manganese is a natural essential mineral belonging to the supplement class.

Manganese is also known as Mn and manganum.

Manganese is a vital element for healthy immunological function, blood sugar regulation, cellular energy, reproduction, digestion, bone formation, blood clotting, hemostasis, and protection against reactive oxygen species.

Manganese deficiency leads to bone weakening, slows growth in kids, skin problems, hair colour loss, and lower cholesterol in men. It also affects women's mood and premenstrual discomfort.

Whole grains, clams, oysters, nuts, seeds, tea, whole grains, mussels, soybeans and other legumes, rice, leafy vegetables, coffee, tea, and many spices, such as black pepper, are rich sources of manganese.

Manganese is absorbed in the small intestine and transported by blood to tissues, contributing to bone growth and brain function. Bile and urine expel the excess manganese from the body.

The common side effects of manganese include nausea, vomiting, diarrhoea, mild tremors and mood changes.

Manganese is available in tablets, capsules and injectable solutions.

Biochemical action of Manganese

Manganese belonging to the supplement class helps in maintaining a healthy immune system. Manganese acts biochemical pathway.

Manganese is a cofactor for numerous enzymes involved in metabolism, including those that help in energy synthesis, amino acid metabolism, and antioxidant defence. Manganese promotes the production of connective tissue, bone development, and optimal brain function. Detoxification is involved in synthesising certain enzymes required by the body. Manganese is also involved in the synthesis of sex hormones and neurotransmitters. Excessive manganese consumption, on the other hand, can be neurotoxic. Maintaining a balance of manganese intake is essential for maintaining its key functions while avoiding potential toxicity.

Manganese is available in tablets, capsules and injectable solutions.

• Tablets/capsules: To be swallowed whole with water/liquid, as applicable.
• Injectable solutions: To be administered parenterally, as applicable.

Manganese can be used as a supplement when the amount of manganese taken from the diet is insufficient.

Manganese supplements may be used to prevent and treat manganese deficiency, a condition in which the body needs manganese.

Adequate oral intake of manganese supplements enhances normal brain and nerve function.

Manganese supplement helps regulate fat and carbohydrate metabolism, calcium absorption, and regulate blood sugar.

Vitamins and natural supplements should not replace a balanced diet.

This product is not intended to diagnose, treat or prevent any disease(s).

Manganese may be useful as a supplement for the following health benefits:

• Antioxidant: Manganese is an essential component of the antioxidant enzyme superoxide dismutase (SOD), which protects cells from free radicals that cause ageing, heart disease, and cancer. SOD converts dangerous superoxide radicals into safer compounds, thereby protecting cells. Low SOD levels may increase the risk of heart disease, and diminished SOD activity is evident in disorders such as rheumatoid arthritis. Adequate manganese consumption promotes SOD function, which may reduce disease risks by boosting antioxidant defences.
• Bone health: Manganese serves as a cofactor for a number of enzymes involved in bone production. Manganese supplementation can improve both bone mineral density and bone formation.
• Diabetes: Although there have been few human clinical trials, manganese supplementation may improve endothelial dysfunction in diabetes, lower oxidative stress, and increase glucose tolerance. More research is needed to determine whether manganese possesses a role in diabetes development.
• Stroke: Manganese is a vasodilator, which helps enlarge veins so blood can circulate more efficiently to regions like the brain. Adequate manganese levels in the body can help increase blood flow and reduce the risk of specific health problems such as strokes.
• Premenstrual Symptoms (PMS): Clinical study suggests combining manganese and calcium may help improve premenstrual syndrome (PMS) symptoms.

Manganese supplementation may be administered orally or parenterally.

• Orally: Manganese supplements are available as tablets and capsules that can be taken orally. It is best taken with a meal or food.
• Parenterally: Manganese supplements are generally taken by mouth but may have to be administered intravenously to all patients who require parenteral nutrition (PN).

The dosage and duration of treatment should be as per the clinical judgment of the treating healthcare professional).

Vitamins and natural supplements should not replace a balanced diet

This product is not intended to diagnose, treat or prevent any disease(s).

• Tablet: 10mg (elemental), 15mg (elemental), 93mg (aspartate; 25mg elemental), 50mg (gluconate; 5.7mg elemental)

• Capsule: 16.67mg

• Injectable solution: 0.1mg/mL

Manganese is available in tablets, capsules and injectable solutions.

Manganese supplementation may be contraindicated in the following conditions:

• Hypersensitivity; sensitive to Manganese
• Iron-deficiency anemia
• Chronic kidney disease
• Hepatic impairment

For individuals on hemodialysis, manganese from supplements might need to be absorbed better in people.

Manganese supplements should be used cautiously in liver/biliary tract dysfunction.

Since manganese supplement is acidic, it should be cautiously administered intravenously or intramuscularly directly without dilution may cause tissue damage.

Aluminium is present in the injection; use caution in patients with renal impairment and premature newborns.

Caution is advised when consuming alcohol with Manganese.

It is excreted in breastmilk; Use cautiously during breastfeeding.

Unsafe to use during pregnancy.

Limit the consumption of foods and drinks higher in added sugars, saturated fat, and sodium alcoholic beverages, as these substances could hinder Manganese absorption.

The adverse reactions related to manganese can be categorized as-

• Common: Tremors, muscle rigidity, impaired coordination, respiratory and digestive issues
• Less Common: Cognitive changes, mood disturbances, speech difficulties, skin irritation and visual disturbances.
• Rare: Parkinson's-like symptoms, intellectual impairments and psychiatric symptoms.

No major clinically significant interactions between manganese and drugs are currently known. However, the following is a brief list of specific minor medication interactions involving manganese that indicate the need for caution when used together:

• Quinolone antibiotics: Manganese can bind to quinolone antibiotics in the stomach, reducing their absorption by the body. This might lessen their impact. Take manganese supplements at least an hour after taking quinolone antibiotics to prevent this interaction.
• Tetracycline antibiotics: The amount of tetracycline antibiotics that are possibly absorbed by the body is reduced when manganese binds to them in the stomach. This may reduce their effect. Take manganese two hours before or four hours after taking tetracyclines to prevent this interaction.
• Antipsychotic drugs: Some individuals may have worsened adverse effects from manganese when taking certain antipsychotic medications.

The common side of Manganese includes the following:

• Nausea
• Vomiting
• Diarrhoea
• Skin rash
• Mild tremors
• Changes in mood
• Muscle rigidity
• Difficulty with movement coordination

The use of Manganese should be prudent in the following group of special populations.

• Pregnancy:

Pregnancy Category: C. Safe during pregnancy, but when taken in high doses, use caution if the benefits outweigh the risks.

The RDA for manganese in pregnant women is 2 mg/day.

• Paediatrics:

Manganese supplements are essential for children in maintaining the heart and blood vessels. It also preserves the health of the skin and cardiac muscle. It might help in the treatment and prevention of cancer.

Manganese supplements are the best way to help children get enough Manganese daily.

The RDA for manganese in paediatrics ranges from 0.3-2.2 mg/day.

Dosage Adjustment for Paediatric Patients

There are no specific dosage adjustments provided.

• Geriatrics:

There is no sufficient scientific evidence traceable regarding the use and safety of Manganese for use in special populations.

• Lactating mothers:

When consumed more than RDA, Manganese may excrete in the breast milk and harm a breastfeeding infant, so it is advised to use it cautiously.

The RDA for manganese in lactating mothers is 2.6 mg/day.

Dosage Adjustment in Kidney Impairment

There are no specific dosage adjustments provided.

Dosage Adjustment in Hepatic Impairment

There are no specific dosage adjustments provided.

Dosage Adjustment for Adult Patients

Prevention of Deficiency

Parenteral solution (TPN):150-800 mcg/day IV

Osteoporosis (Off-label)

5 mg PO qDay

The physician should be vigilant about the knowledge pertaining to identifying and treating overdosage of manganese. Overdosing on manganese supplements may lead to manganism characterised by symptoms such as movement disorders, cognitive impairments, and psychiatric symptoms.

There is no specific antidote or treatment for excessive intake of supplemental manganese. Manganese should be immediately terminated, followed by chelation therapy to remove excess manganese from the body if an overdose occurs. Supportive treatment should also be given, along with addressing any symptoms that persist or worsen. Physical therapy might be added if necessary.

Manganese is a trace mineral that acts as a cofactor for several enzymes in the body. It is essential in various metabolic processes, such as energy metabolism, antioxidant defence, bone building, and neurotransmitter synthesis. Manganese is necessary for activating enzymes such as manganese superoxide dismutase (MnSOD), which helps protect cells from oxidative damage. It also helps make collagen, an essential component of connective tissues and bones. Manganese enters the bloodstream linked to transferrin after being absorbed in the small intestine. Excess manganese is mostly eliminated in the form of bile and faeces. While manganese is required for many physiological activities, overexposure to high quantities of manganese can result in neurotoxicity and negative health repercussions. As a result, maintaining an ideal manganese is essential for overall health and well-being.

Kinetic profile:

• Absorption: Manganese is mainly absorbed in the small intestine through an active transport mechanism and then transported into the circulation while mainly attached to the protein transferrin.
• Distribution: It distributes throughout tissues, but the liver, pancreas, and bone contain the highest amounts.
• Metabolism: The liver absorbs manganese from the blood, transferrin, and possibly 2-macroglobulin and albumin, and transports it to extrahepatic organs. Manganese is incorporated into proteins and enzymes during this process.
• Elimination: The bile excretes most manganese, leaving the body through faeces. Urinary excretion constitutes a smaller fraction. The liver and gallbladder regulate this excretion mechanism.

1. https://www.ncbi.nlm.nih.gov/books/NBK554545/
2. https://ods.od.nih.gov/factsheets/Manganese-Consumer/
3. https://ods.od.nih.gov/factsheets/Manganese-HealthProfessional/
4. https://www.ncbi.nlm.nih.gov/books/NBK222332/